Early identification of stroke type could be key to reaping the benefits of very early ambulance blood pressure-lowering treatment in patients with suspected acute stroke, according to new research.
The findings were presented in the 10th Conference of the European Stroke Organization in Basel, Switzerland and published simultaneously in the New England Journal of Medicine.1
Professor Craig Anderson, director of Global Brain Health at the George Institute for Global Health and principal investigator of the study, said that although more research is needed, the results provided a potential avenue to improve outcomes in patients with the most common type of stroke. mortal.
“Our study shows clear benefits of early administration of blood pressure-lowering treatment to patients with intracerebral hemorrhage in the ambulance, although overall there was no difference in the outcome of this early intervention for all patients with suspected stroke.
“In fact, in patients with a final diagnosis of ischemic stroke, their outcome actually worsened, so the ability to make a reliable diagnosis at this early stage is key to reaping the benefits of very early blood pressure treatment.” “.
The Intensive Ambulance Blood Pressure Reduction Trial in Hyperacute Stroke (INTERACT4) was a multicenter, randomized, open-label, outcome-blind study conducted in dozens of ambulance services in China.
2404 patients evaluated by ambulance with suspected acute stroke causing motor deficit within two hours of onset and elevated systolic blood pressure (≥150 mmHg) were randomly assigned to immediate blood pressure reduction (target 130- 140 mmHg) or regular blood pressure (BP) control. at the hospital.
The prehospital ambulance-initiated BP lowering group with hemorrhagic stroke had a 30% lower probability of a poor functional outcome, while the cerebral ischemia group had an equivalent 30% higher probability of a poor functional outcome, in compared to patients with these stroke patients. types who received routine BP monitoring upon arrival at the hospital.
Overall, the effects of prehospital BP lowering had a balanced benefit and harm, such that there were no overall differences in functional outcome among those receiving usual care in all stroke patients. Between-group rates of serious adverse events were similar.
About 80 percent of strokes worldwide are ischemic, caused by loss of blood flow to an area of the brain due to a blockage in a blood vessel, leading to a loss of neurological function.1
Intracerebral hemorrhage (ICH) accounts for more than a quarter of all stroke cases and occurs when blood leaks from a blood vessel into brain tissue. ICH is the deadliest type of stroke: up to a third of patients die within 30 days, and it is most common in China, where the study was conducted.2
“All treatments for acute stroke are highly time-dependent: brain cells die quickly when they are deprived of oxygen. But knowing the best treatment approach to take before you can identify the type of stroke a person has experienced patient is difficult without brain imaging. Professor Anderson said.
“The results do not support ambulance administration of blood pressure-lowering treatment in patients with suspected acute stroke; that is clear.
“But in recent years, we have seen the introduction of mobile stroke ambulances equipped with a CT scanner and other diagnostic tools that aim to identify cases of ischemic stroke for early administration of anticoagulant treatment.
“But our results support the idea that ambulance treatment also be given to patients with hemorrhagic stroke.
“In the meantime, although acute stroke treatment is performed in the hospital, faster diagnosis and action as soon as the patient arrives at the emergency department is critical to preserving brain function.”
References
- GBD Stroke Collaborators 2019. Global, regional and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurology 2021;20:795-820
- Wu S, et al. Stroke in China: advances and challenges in epidemiology, prevention and management. Lancet Neurology 2019;18:394-405